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In dermal melasma, the excess pigment is located in the dermis

Available at Peer Review File: Available at Conflicts of Interest : Both authors have completed the ICMJE uniform disclosure form (available at The series Liver Diseases: Symptoms, Causes and Novel Therapies was commissioned by the editorial office without any funding or sponsorship

Studies demonstrate rapid systemic uptake and targeted activity at endothelial and fibroblastic levels, implicating it in nitric oxide modulation, collagen synthesis, and vascular repair

However, it should be possible if needed by measurement of gamma-glutamylcysteine synthetase activity or mutational analysis (if the mutation in the family is known) of chorionic villi or cultured amniocytes